嗅觉障碍患者鼻内镜术后嗅黏膜形态学观察

Morphological changes of olfactory mucous in patients with dysosmia before and after endoscopic sinus surgery

目的观察嗅觉丧失患者鼻内镜术后嗅觉不同恢复程度、不同时间嗅黏膜的组织学情况。方法按孙安纳法配制试嗅液,选取慢性鼻窦炎鼻息肉嗅觉丧失患者33例(60侧)功能性鼻内镜术后第4、12、24周测试嗅觉并取嗅区黏膜。术后24周随机选取嗅觉恢复正常、部分恢复和无恢复每组各5例和2例正常者的嗅区黏膜行透射电镜观察。结果术前嗅上皮均表现为不同程度的损伤。术后4周细胞损伤程度加重。术后12周嗅觉完全或部分恢复组,细胞形态趋于正常,组间无明显差别。嗅觉无恢复组,细胞形态改善。术后24周,嗅觉完全或部分恢复组,细胞形态恢复正常,较术后12周时好,比对照组更佳。嗅觉无恢复组,细胞形态趋于正常。结论慢性鼻窦炎鼻息肉嗅觉障碍与嗅上皮形态学异常有关。鼻腔通气引流和细胞形态学恢复是嗅觉恢复的必要条件。

Objective To observe the histological changes of the olfactory mucosa in patients with dysosmia before and after endoscopic sinus surgery （ESS）. Methods Thirty-three patients （60 sides ） with chronic rhinosinusitis, nasal polyps and dysosmia were all detected by the smell identification test of Sun＇ anna. Olfactory identification and biopsy specimens were obtained from the olfactory region before operation, and 4 weeks, 1 2 weeks, and 2 4 weeks after ESS.-Five olfactory mucosa specimens from each of the complete recovery group, partial restoration group and no improvement group were stochasticly selected at 24 weeks after ESS and two specimens of normal olfactory mucosa were taken as control. All the specimens were observed through transmission electronmicroscopy. Results The olfactory mucosa showed lesions of various degree before surgery. Further lesions were observed at 4 weeks after surgery. At 12 weeks, cellular morphology tended to be normal in both complete recovery and partial restoration groups between them there was significant difference. In the no improvement group, cellular morphology got improved. At 2 4 weeks, cellular morphology was normal in both complete recovery and partial restoration groups, which was much better than that at 1 2 weeks, even better than that of the control group. In the no improvement group, cellular morphology tended to be normal. Conclusion Dysosmia secondary to chronic rhinosinusitis and nasal polyps is relevant with the morphologic abnormality of olfactory epithelia. Well ventilation of the nasal cavity and normal cell morphology are essential for olfactory recovery.